Chronic Diseases and Conditions

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Diabetes was the sixth leading cause of death in the United States in 2000, and is now the leading cause of both end-stage renal disease and blindness in adults. Control of blood sugar levels can reduce the risk of developing these diabetes-related complications. By keeping more medical appointments and taking diabetes medications as directed, patients with diabetes can substantially improve their blood sugar (HbA1c) levels, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS09722).

Researchers retrospectively evaluated 1,560 patients with type 2 diabetes who visited a diabetes clinic which served a predominantly urban, indigent, black population, between 1991 and 2001. The patients returned for a follow-up visit and HbA1c measurement after 1 year of care. The researchers assessed the number of scheduled visits that the patients kept, and the percentage of visits in which they reported taking their medication as recommended. On average, patients had been diagnosed with diabetes for nearly 5 years and had a baseline HbA1c of 9.1 percent (normal levels are below 7 percent).

After adjusting for other factors affecting HbA1c levels such as body mass index and diabetes therapy, patients who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6 percent with six to seven visits vs. 9.7 percent with no intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8 percent with 76-100 percent adherence). The authors conclude that keeping scheduled appointments and taking recommended medications are critical "diabetes survival skills" which need to be emphasized in education programs aimed at both patients and providers.